Texture-modified Diets Research Articles

Speech-language pathologists’ experience with nursing initiated texture modified diets in health care settings

BACKGROUND: Texture modified diets (TMDs) are among the most widely used compensatory measures for managing dysphagia. TMDs are associated with significant risks involving nutrition, hydration, and quality of life. Speech-language pathologists (SLPs) are trained to evaluate and treat people with dysphagia and to assess client-specific appropriateness of TMDs. However, patients are regularly placed on TMDs by nursing staff without formal training in dysphagia and without SLP consult (Gurevich et al., 2021). OBJECTIVE: This study explores the experience of SLPs in health care with respect to such nursing initiated TMDs with the goal of assessing the prevalence of this practice. METHOD: SLP students, clinical fellows, and practicing clinicians (N = 503) were surveyed regarding their exposure to the nursing initiated TMD practice. RESULTS: Overall, 78.9% of respondents have directly encountered the nursing initiated TMD practice, with an additional 10% having heard of it. The group most susceptible to this practice, the certified clinicians who work with dysphagia alongside nurses (n = 461), had a higher rate of directly encountering this practice (82.2%). Among these, the early career clinicians (n = 104) had an even higher direct encounter rate at 87.5%. CONCLUSIONS: Findings show that nursing initiated TMDs are pervasive in United States (U.S.) health care, and SLPs are shown to regularly face this issue in their work settings as soon as they enter the workforce. Given negative outcomes associated with TMDs, patient care would be best served if decisions to implement TMDs were made by personnel with training in dysphagia.

Co (ne) víme o úpravě konzistence stravy u pacientů s dysfagií a s čím by mohla pomoci iniciativa IDDSI (International Dysphagia Diet Standardization Initiative)

Summary Texture-modified diet and thickening liquids are a therapeutic option for dysphagia. Many of the terms referring to liquid viscosity modifications and solid diet modifications are terminologically ambiguous and vague, e. g. “honey consistency liquid” or “soft-textured diet.” The inconsistent terminology adversely affects patient safety and the efficiency of the application of this therapeutic method. Possible misunderstanding of the vague terms between staff members can result in using a different consistency of the fluid or food from the consistency that was found to be safe during the objective swallowing examination. The International Dysphagia Diet Standardization Initiative (IDDSI) is seeking application of international standardized terminology for texture-modified foods and liquids for use in people with dysphagia of all ages, in all care settings, and in different cultural settings. The goal of IDDSI is to improve patient safety of oral intake and evolve the field of dysphagia research. Key words dysphagia – texture-modified food – thickened liquids – IDDSI

Characterization of Chinese shrimp (Fenneropenaeus chinensis) powder and corn starch composite gels as dysphagia diet

In the present study, the effects of corn starch (CS) on the properties of Chinese shrimp (Fenneropenaeus chinensis) powder (SP) were characterized to explore the feasibility of developing dysphagia diet. The SP/CS gels were prepared by adding CS at different concentrations. The SP/CS mixture presented low gel properties at CS concentrations ranging from 12 to 48 mg/mL, but did demonstrate gelation behavior with the highest G′ value of 1134.2 Pa and a water holding capacity of 90% at 60 mg/mL. As the CS concentration increased, the stability of the SP/CS mixture also improved, as evidenced by the significantly reduced relaxation times T22 and T23, enhanced gel network formation, and the presence of hydrogen bonding and electrostatic interactions between SP and CS. Furthermore, the international dysphagia diet standardisation initiative (IDDSI) swallowing level of the SP/CS mixtures were 2, 3, 4, and 5 at CS concentrations of 12, 24, 36, 48 and 60 mg/ml, respectively. The SP/CS-60 mixture gel was considered suitable for dysphagia patients. These findings suggest that the gel properties of SP can be modified by CS, and that the SP/CS mixture gels have the potential to be used as a texture-modified diet with high-quality protein for dysphagia patients.

Impact of pureed and liquidised diets on health-related quality of life scores in older patients during postacute rehabilitation: A pilot study.

Consuming texture-modified diets was considered to negatively affect health-related quality of life (HR-QoL). However, the precise relationship between the levels of food texture consumed and HR-QoL remains uncertain. The present study aimed to determine the association between levels of food texture consumed and HR-QoL. This cross-sectional study included 122 hospitalised patients aged ≥ 65 years (mean ± SD age 78.9 ± 7.9 years; 48.4% female) who required postacute rehabilitation. Consumed food texture levels were classified using the International Dysphagia Diet Standardization Initiative (IDDSI) framework 2.0. HR-QoL was evaluated using the five-level EuroQoL five-dimension (EQ-5D-5L). The association between food texture levels and HR-QoL was analysed using a multivariate linear regression model. The lower food texture levels consumed were associated with significantly lower EQ-5D-5L scores. Consumption of pureed (IDDSI Level 4) and liqudised (IDDSI Level 3) diets were associated with lower EQ-5D-5L scores among older patients undergoing postacute rehabilitation (regression coefficient -0.304; 95% confidence interval = -0.472 to -0.137 and regression coefficient, -0.444, 95% confidence interval = -0.676 to -0.213, respectivly). The findings suggest a link between the consumption of pureed and liquidised diets and lower HR-QoL scores in older hospitalised patients undergoing rehabilitation. To establish a clearer cause-and-effect relationship, future research should encompass multicentre and longitudinal studies, building upon the insights from the present study.

Impact of a moulded pureed diet on taste, appearance, recognisability, and overall liking among patients in an acute hospital.

Hospital meals potentially influence patients' nutritional, physical, and emotional well-being during their admission. Patients on pureed diets report poorer meal satisfaction, due to taste, appearance, and recognisability, potentially impacting on their nutritional status. This study compared whether a moulded pureed diet made from modified maize starch led to improved taste, appearance, recognisability, and overall liking, compared to an unmoulded pureed diet made from potato starch in an acute hospital. Patients on texture-modified diets were recruited and presented with two pureed diets - unmoulded and moulded. Participants were asked to identify meat and vegetable dishes prior to eating. After the meal, participants indicated their diet preference in terms of appearance, taste, and overall liking. 145 participants were recruited, of which 126 completed data collection. 86% correctly identified moulded meat dishes, 69% correctly identified moulded vegetable dishes, with an overall 77% accuracy in identifying moulded puree side dishes. On unmoulded puree side dishes, participants correctly identified 25% of meat dishes, 4% of vegetable dishes, with an overall accuracy of 14%. In terms of preference, the moulded puree was preferred, with 81% for appearance, 76% for taste and 75% for overall preference. When participants had differing preferences for appearance and taste (e.g., prefers unmoulded puree appearance and moulded puree taste), 95% of them subsequently aligned their overall preference with their taste preference (i.e., overall preferred moulded pureed diet). This suggests that taste has a stronger influence on overall preference compared to appearance. Findings indicate that a moulded pureed diet made from modified maize starch led to improved recognisability, taste, appearance, and overall liking compared to an unmoulded pureed diet made from potato starch. Taste had a stronger influence on overall preference compared to appearance. These findings capture patient preferences and may have implications on how hospital pureed diets may be improved, potentially improving patient nutrition and health outcomes.

Measuring the Rheological and Textural Properties of Thick Purees Used to Manage Patients with Swallowing Disorders.

Texture-modified diets are the first-line compensatory strategy for older patients with swallowing and mastication disorders. However, the absence of a common protocol to assess textural properties inhibits their standardization and quality control and, thus, patient safety. This study aimed to (a) assess the rheological and textural properties of ten thick purees (Texture C, British Dietetic Association), (b) understand the effect of oral processing, and (c) measure the properties of the ready-to-swallow bolus after oral processing in healthy adults. Shear viscosity at 50 s-1 and 300 s-1 and textural properties (maximum force, cohesiveness, and adhesiveness) of boluses of ten thick purees were analyzed with a rheometer and a texture analyzer before and after oral processing (ready-to-swallow) in five healthy volunteers. Viscosity varied by 81.78% at 50 s-1 (900-4800 mPa·s) among purees before oral processing. Maximum force varied by 60% (0.47-1.2 N); cohesiveness, 18% (0.66-0.82), and adhesiveness, 32% (0.74-1.1 N·s). The high variability of viscosity was also present in ready-to-swallow boluses, 70.32% among purees. Oral processing significantly reduced viscosity in most purees (French omelet, zucchini omelet, turkey stew, red lentils, noodles, and hake fish) and also significantly reduced maximum force (7-36%) and adhesiveness (17-51%) but hardly affected cohesiveness (<5%). All thick purees met the qualitative textural descriptors for Level C texture. However, all ten purees showed significant differences in all parameters measured instrumentally and were affected differently by oral processing. This study demonstrates the need to use instrumental quality control using standardized protocols and SI units to narrow the variability and provide the optimal values for patients with dysphagia who require texture-modified diets.

Effect of a texture-modified and controlled bolus volume diet on all-cause mortality in older persons with oropharyngeal dysphagia: Secondary analysis of a randomized controlled trial.

Oropharyngeal dysphagia (OD) is common among older adults. Some studies have evaluated the efficacy of a texture-modified diet on mortality but with short-term follow-up. We aimed to evaluate the effect of a texture-modified diet and controlled bolus volume on all-cause mortality after 12 months in older persons with OD. This secondary analysis of a randomized clinical trial included patients aged ≥60 years with a diagnosis of OD. They were concurrently and randomly assigned to receive either a texture-modified food diet and controlled bolus volume (intervention group) or standard treatment (control group) with 12 months of follow-up. Secondary outcomes were oral intake, weight, handgrip strength, phase angle, and aspiration pneumonia. Kaplan-Meier analysis and the Cox proportional hazards model were used for mortality analysis. A total of 127 participants (intervention group: 64 and control group: 63) were recruited, with a mean age of 76 years. The probability of all-cause mortality was significantly lower in the intervention group (n = 8, 12%) than in the control group (n = 18, 29%) (hazard ratio = 0.36 [95% CI = 0.16-0.86]; P = 0.01). There were 5 (7.9%) and 10 (16.1%) aspiration pneumonia events in the intervention and control groups, respectively (not significant) in 12 months of follow-up. Changes were observed in protein consumption (P = 0.01), body weight (P = 0.04), body mass index (P = 0.004), handgrip strength (P = 0.02), and phase angle (P = 0.04) between the treatment groups. Compared with the standard treatment, the dietary intervention improved efficacy by limiting nutrition complications, aspiration pneumonia, and all-cause mortality.

Endoscopic and observational findings of swallowing of traditional and molded puree in healthy individuals.

Puree is commonly prescribed for patients with mastication and bolus formation difficulties, but its appearance might negatively impact appetite and intake. Molded puree is marketed to be an alternative to traditional puree, but the process of molding puree could alter the properties of the food significantly and lead to different swallowing physiology as compared to puree. The current study investigated the differences between traditional and molded puree in terms of swallowing physiology and perception in healthy individuals. Thirty two participants were included. Two outcomes were used to quantify the oral preparatory and oral phase. Fibreoptic endoscopic evaluation of swallowing was used to assess the pharyngeal phase as it could retain the purees in their original form. Six outcomes were collected. Perceptual rating of the purees were provided by participants in six domains. Molded puree required significantly more masticatory cycles (p < 0.001) and longer time for ingestion (p < 0.001). Molded puree had longer swallow reaction time (p = 0.001) and more inferior site of swallow initiation (p = 0.007) compared with traditional puree. Participants' satisfaction with the appearance, texture and overall of molded puree was significantly greater. Molded puree was perceived to be more difficult to chew and swallow. This study established that the two types of puree were different in various aspects. The study also provided important clinical implications regarding the use of molded puree as a form of texture modifieddiet (TMD) in patients with dysphagia. The results could serve as the foundation of larger cohort studies on the effect of various TMDs on patients with dysphagia.

Will levels of experience of examiners affect the diet provided for patients with swallowing impairment?

ObjectiveFlexible endoscopic evaluation of swallowing (FEES) is widely performed to determine the safety of oral intake. However, evaluation results can vary among examiners depending on their experience. To analyze the impact of such differences, we investigated the diet provided for patients with swallowing impairment evaluated by experienced and inexperienced examiners. MethodsWe included 20 subjects with swallowing impairment. They underwent FEES twice, once by an experienced examiner (EE) and once by an inexperienced examiner (IE), in random order. The second FEES was generally performed within one month of the first FEES. The diet provided by the EE (EE results) and by the IE (IE results) during and after FEES was investigated and statistically compared. Respiratory and oral intake conditions at each time of FEES were also investigated and the results were included in the corresponding EE or IE results. ResultsThe median interval between FEES was 13.5 days. There was no significant difference between the EE and IE results regarding swallowing impairment-related conditions, such as amount of sputum suctioned, oral intake status, or prevalence of fever after FEES. However, there was a significant difference in the texture-modified diet provided after FEES: A close-to-normal diet was provided by the EE compared to the diet provided by the IE. ConclusionThis study demonstrated a difference in the provided diet for patients with swallowing impairment between the examiners with different levels of experience. Our results suggest that EEs may be able to safely recommend patients with swallowing impairment have a close-to-normal diet.

Multidisciplinary Assessment and Individualized Nutritional Management of Dysphagia in Older Outpatients.

The evidence on the efficacy of nutrition therapy to prevent complications of dysphagia is based on observational studies that used different tools for nutritional and dysphagia assessment, and different scales for the definition of diet textures, rendering their results incomparable and the knowledge on dysphagia management inconclusive. This retrospective observational study was performed in 267 older outpatients who were assessed for dysphagia and nutritional status by a multidisciplinary team at the Clinical Nutrition Unit of IRCCS INRCA geriatric research hospital (Ancona, Italy) from 2018 to 2021. GUSS test and ASHA-NOMS measurement systems were used for dysphagia assessment, GLIM criteria for the assessment of nutritional status, and the IDDSI framework to describe the texture-modified diets. Descriptive statistics were used to summarize the characteristics of the subjects evaluated. Sociodemographic, functional and clinical parameters were compared between patients with and without BMI improvement overtime by an unpaired Student's t test, Mann-Whitney U test or Chi square test, as appropriate. Dysphagia was diagnosed in more than 96.0% of subjects; 22.1% (n = 59) of dysphagic subjects were also malnourished. Dysphagia was treated exclusively by nutrition therapy, prevalently by individualized texture-modified diets (77.4%). For the classification of diet texture, the IDDSI framework was used. The follow-up visit was attended by 63.7% (n = 102) of subjects. Aspiration pneumonia was registered only in one patient (less than 1%), and BMI improved in 13 of 19 malnourished subjects (68.4%). The improvement of nutritional status was primarily reached in subjects whose energy intake was increased and texture of solids modified, in younger subjects, and in those taking less drugs and not reporting any weight loss before the first assessment. The nutritional management of dysphagia must guarantee both an adequate consistency and energy-protein intake. Evaluations and outcomes should be described with universal scales, in order to allow for comparison between studies and contribute to the collection of a critical mass of evidence on the efficacy of texture-modified diets in the management of dysphagia and its complications.

Hydrophilic colloids (Konjac gum/Xanthan gum) in 3D printing of transitional food from fish paste

Hydrocolloids are often used as thickeners to create texture-modified diets for people with dysphagia. The effect of different konjac gum (KGM)/xanthan gum (XG) ratios (12/0, 5/1, 3/1, 1/1, 1/3, 1/5, 0/12, w/w) on rheological properties, 3D printability, textural properties, microstructure, and the proteoglycan interactions of cooked sturgeon pastes were investigated. The sturgeon pastes with different KGM/XG ratios demonstrated shear-thinning behavior and excellent viscoelasticity which made it good feedstock for 3D printing. The texture properties of the sturgeon paste with different KGM/XG ratios were all significantly improved (p < 0.05) comparing to the control, and satisfied the potential transitional foods in the International Dysphagia Diet Standardization Initiative (IDDSI) framework. The hardness (660.62 g) and water holding capacity (98.12%) maximized at the KGM/XG ratio of 1/1. The addition of KGM/XG mainly promotes cross-linking between protein to strength the network structure through hydrogen bonding.

Nutritional Management in Adult Patients With Dysphagia: Position Paper From Japanese Working Group on Integrated Nutrition for Dysphagic People.

This position paper prepared by the Japanese Working Group on Integrated Nutrition for Dysphagic People (JWIND) aims to summarize the need for nutritional management in adult patients with dysphagia, the issues that nutrition professionals should address, and the promising approaches as well as to propose a vision for the future of nutritional care for adult patients with dysphagia. JWIND is a joint certification system recognized by the Japan Dietetic Association and the Japanese Society of Dysphagia Rehabilitation; its members are mostly experts known as "Certified Specialist of Registered Dietitian for Dysphagia Rehabilitation." Malnutrition and dysphagia are associated with each other. Therefore, malnutrition detection and intervention are essential for patients with dysphagia. However, evidence on the usefulness nutritional assessment and intervention to ensure appropriate nutritional care remains insufficient. Here, we present current knowledge of the relationship between primary diseases causing dysphagia and malnutrition, the indicators used for nutritional assessment, and nutritional interventions such as texture-modified diet (TMD) quality improvement, oral nutritional supplementation, and comprehensive intervention. We also discuss the current status and issues in nutritional care for adult patients with dysphagia. Furthermore, we have proposed measures that nutrition professionals should consider based on 3 perspectives: nutritional assessment, TMD, and nutritional intervention. Individualized and specialized nutritional management by registered dietitians (RDs) through appropriate assessment of the nutritional status of adult patients with dysphagia is needed. To maintain and improve swallowing function and nutritional status, RDs should intervene from the state of risk or early dysphagia onset, providing individualized care per their expertise as part of a multidisciplinary team. However, systematic clinical practice and research regarding the association of nutrition with dysphagia are currently insufficient. Therefore, further clinical practice and evidence building, including the verification of the efficacy on nutritional support through intervention research, are needed.

3D Food Printing Applications Related to Dysphagia: A Narrative Review.

Dysphagia is a condition in which the swallowing mechanism is impaired. It is most often a result of a stroke. Dysphagia has serious consequences, including choking and aspiration pneumonia, which can both be fatal. The population that is most affected by it is the elderly. Texture-modified diets are part of the treatment plan for dysphagia. This bland, restrictive diet often contributes to malnutrition in patients with dysphagia. Both energy and protein intake are of concern, which is especially worrying, as it affects the elderly. Making texture-modified diets more appealing is one method to increase food intake. As a recent technology, 3D food printing has great potential to increase the appeal of textured foods. With extrusion-based printing, both protein and vegetable products have already been 3D printed that fit into the texture categories provided by the International Dysphagia Diet Standardization Initiative. Another exciting advancement is 4D food printing which could make foods even more appealing by incorporating color change and aroma release following a stimulus. The ultra-processed nature of 3D-printed foods is of nutritional concern since this affects the digestion of the food and negatively affects the gut microbiome. There are mitigating strategies to this issue, including the addition of hydrocolloids that increase stomach content viscosity and the addition of probiotics. Therefore, 3D food printing is an improved method for the production of texture-modified diets that should be further explored.

Exploring Meal Provision and Mealtime Challenges for Aged Care Residents Consuming Texture-Modified Diets: A Mixed Methods Study.

Dysphagia has become more prevalent with age. Thus, the demand for texture-modified diets (TMDs) has increased. While the nutritional perspectives have been studied, the provision of TMDs and mealtime practice has received less attention. This study aimed to explore the TMD provision and mealtime challenges of residents requiring TMDs in aged care facilities. The study was conducted across five aged care facilities using a mixed methods design involving 14 TMD menu audits by a foodservice dietitian, 15 mealtime observations, and semi-structured interviews with residents and staff (n = 18). TMD menus failed to meet all nutrition requirements and foodservice and clinical standards based on the dietitian NZ foodservice and nutrition audit tool. A content analysis offered three main themes: (1) Foodservice production. Inconsistent quality and meal portions were observed. The variety, choice, and portion size of TMDs required improvement based on the residents’ preferences; (2) Serving procedures. There was a lack of standardisation of meal distribution and feeding assistance; and (3) Dining environment. The dining room set-up varied across facilities, and residents expressed different preferences towards the dining environment. There is a need to improve staff awareness of mealtime consistency and optimise feeding assistance. The dining environment should be individualised to accommodate residents’ psychosocial needs. Standardised policies and continuous training can facilitate quality mealtime implementation.

Association between food texture levels consumed and the prevalence of malnutrition and sarcopenia in older patients after stroke.

Texture-modified diets (TMDs) may affect nutritional status and sarcopenia in patients after stroke. This study aimed to investigate the association of food texture levels consumed by patients after stroke with the prevalence of malnutrition and sarcopenia. This was a two-center cross-sectional study. A total of 443 patients aged ≥65 years undergoing post-stroke rehabilitation and with oral intake in rehabilitation wards in Shizuoka prefecture and Okinawa prefecture, Japan, were included in the analysis. Food textures were categorized according to the International Dysphagia Diet Standardization Initiative (IDDSI) framework. Malnutrition was diagnosed according to the Global Leadership Initiative on Malnutrition and sarcopenia was assess by the European Working Group on Sarcopenia in Older People 2 criteria. The Cochran-Armitage trend test was used to examine the prevalence of malnutrition and sarcopenia by consumption of lower food texture levels. Malnutrition and sarcopenia were diagnosed in 245 (55.3%) and 275 (62.1%) participants, respectively. Consumption of lower food texture levels was associated with a higher prevalence of malnutrition and severe malnutrition (P &lt; 0.001 for both). In addition, consumption of lower food texture levels was associated with a higher prevalence of probable sarcopenia and sarcopenia (P &lt; 0.001 for both). On multivariate analysis, significant associations were observed between IDDSI levels 5 (P &lt; 0.001) and 4 (P = 0.009) and malnutrition, and between IDDSI levels 6 (P = 0.015), 5 (P = 0.033), and 4 (P = 0.015) and sarcopenia. In patients with stroke, consumption of lower food texture levels categorized by the IDDSI framework was associated with a higher prevalence of malnutrition and sarcopenia.

The Effectiveness of International Dysphagia Diet Standardization Initiative–Tailored Interventions on Staff Knowledge and Texture-Modified Diet Compliance in Aged Care Facilities: A Pre-Post Study

ABSTRACTBackgroundThe International Dysphagia Diet Standardization Initiative (IDDSI) has created global standardized definitions for texture-modified diets (TMDs) and thickened liquids to improve the safety and care for individuals with swallowing difficulties. The IDDSI framework guides health care facilities, such as aged care, to provide food to at-risk patients.ObjectivesThis study aims to design, deliver, and evaluate a tailored intervention to facilitate IDDSI implementation in aged care.MethodsFive aged care facilities received tailored interventions, which were guided by the Expert Recommendation for Implementing Change process and used the corresponding barriers identified in the previous study: 1) tailored material, delivery, and planning; 2) opinion leaders and professional input; 3) strategies to attract and involve staff; and 4) reflections and evaluations. Meal compliance against IDDSI standards and staff knowledge acquisition were the primary outcomes evaluating the impact of the intervention. Written consent was obtained from facility managers. Staff trainings were delivered by a dietitian, accompanied with electronic and printed materials. An audit was conducted on all items listed on the TMD daily menu (lunch, dinner, and midmeals). TMD IDDSI audits and staff self-administered surveys were conducted before and 6 mo after the intervention.ResultsAudits of 68 and 79 TMD meals/items were conducted pre- and postintervention, respectively. Significant improvement in meal compliance was found in all 3 levels of TMDs, including soft and bite-sized (50%; P = 0.0001), minced and moist (44%; P = 0.0024), and puréed (42%; P = 0.0024). The overall IDDSI compliance increased by 46% postintervention (P < 0.0001). Staff achieved higher scores in both dysphagia and IDDSI knowledge sections (P < 0.0001).ConclusionsTailored interventions facilitated IDDSI implementation in aged care evidenced by increased TMD compliance and staff knowledge, which remained at 6 mo postintervention.

A Comparison of Dietary Intake and Nutritional Status between Aged Care Residents Consuming Texture-Modified Diets with and without Oral Nutritional Supplements.

Oral nutritional supplements (ONS) are high-energy and protein-rich nutrition drinks that are commonly prescribed to individuals with compromised nutritional status. Aged care residents requiring texture-modified diets are exposed to poor oral intake and malnutrition. This study aimed to investigate the dietary intake and nutritional status of residents consuming texture-modified diets with and without ONS. This multicentre cross-sectional study included 85 residents consuming texture-modified diets (86.0 ± 8.7 y; n = 46 requiring ONS and n = 39 without ONS). A one-day dietary record was completed using a validated visual plate waste estimation method. To determine the adequacy, nutrition intake was then calculated using FoodWorks (Xyris Ltd., Brisbane, Australia) and compared to the recommended dietary intake for Australia and New Zealand. The Mini-Nutritional Assessment Short Form was collected to assess nutritional status. Residents receiving ONS had significantly higher energy, protein, carbohydrates and fat intake than those who did not consume ONS (p < 0.05). No significant differences were found in saturated fat, fibre or sodium intake. With the administration of ONS, residents were able to meet their protein requirement but fell short of their energy and carbohydrates requirements. Both groups had inadequate fibre intake and a high saturated fat intake. A total of 48% of the residents were at risk of malnutrition and 38% were malnourished. Aged care residents requiring texture-modified diets are at high risk of malnutrition as a result of inadequate dietary intake. Administration of ONS may be an effective strategy to optimise nutrition intake.

Redefining the value of snacks for nursing home residents: Bridging psychosocial and nutritional needs

For many nursing home residents, particularly those on texture-modified diets, nutritional needs remain unmet. There is growing recognition of the benefits of increased eating frequency. However, we have yet to systematically investigate resident perceptions of in-between meal snacks. The primary purpose of this study was to identify residents’ snacking preferences and barriers encountered. Ten residents engaged in a total of 17 semi-structured interviews. There was converging support for the significance of snacking. The themes revealed across the interviews highlighted: (a) that desired snack qualities vary across individuals, (b) the valuable non-nutritive contributions of snacks, (c) barriers for getting snacking needs met, and (d) potential benefits of sensory-enhanced snacks. Overall, a disconnect between the food-related emotional “wants” and physical needs of residents likely contributes to malnutrition risk. To improve intake and quality of life, we must better attend to the meaning of food and the individual needs of our residents.

An Evaluation of Texture-Modified Diets Compliant with the International Dysphagia Diet Standardization Initiative in Aged-Care Facilities Using the Consolidated Framework for Implementation Research.

Texture-modified diets (TMDs) are commonly prescribed for older adults with swallowing difficulties to improve swallowing safety. The International Dysphagia Diet Standardization Initiative (IDDSI) provides a framework for terminology, definitions and testing of TMDs. This observational mixed-method study used the consolidated framework for implementation research (CFIR) to establish the barriers and enablers to IDDSI adoption in aged-care facilities (ACFs). Five New Zealand ACFs who had adopted IDDSI > 12months previously were recruited. Evaluation tools were developed based on CFIR constructs, integrating data from (i) mealtime observations; (ii) manager interviews and (iii) staff (nursing, carers and kitchen) self-administrated surveys. All facility and kitchen managers were IDDSI aware and had access to online resources. Three sites had changed to commercially compliant products post-IDDSI adoption, which had cost implications. Awareness of IDDSI amongst staff ranged from 5 to 79% and < 50% of staff surveyed felt sufficiently trained. Awareness was greater in large sites and where IDDSI was mandated by head office. Managers had not mandated auditing and they felt this had led to reduced perceived importance. Managers felt staff required more training and staff wanted more training, believing it would improve food safety and quality of care. Lack of a dedicated project leader and no speech pathologist on-site were perceived barriers. Collaboration between healthcare assistants, kitchen staff and allied health assisted implementation. ACF staff were aware of IDDSI but staff awareness was low. Using the CFIR, site specific and generic barriers and enablers were identified to improve future implementation effectiveness. Managers and staff want access to regular training. Multidisciplinary collaboration and improving communication are essential. ACFs should consider TMD auditing regularly. Successful implementation of IDDSI allows improvement of quality of care and patient safety but requires a systematic, site-specific implementation plan.

Texture-Modified Diets Need to be Improved in Vietnamese Hospitals.

Purpose : The aim of this study is to compare the nutritional status of older adult inpatients consuming Texture-Modified Diets (TMD) to older adult inpatients consuming a regular diet. Methods : The study was designed as cross-sectional and was conducted in three large hospitals in northern Vietnam. The data for 344 older adult inpatients were collected in 2021 by dietitians. Results : The result showed 104 subjects were prescribed TMD. The textures of hospital diets have still not been adequately developed. In particular, the hospitals had not yet developed pureed meals. All older adult inpatients (74.7 ± 6.8 years old, 52.9% female) had 28.8% malnutrition by the GLIM criteria. The TMD group had a malnutrition prevalence two times higher than the regular diet group. Total energy intake from hospital meal and outside snacks in the regular diet group was higher than in the TMD group, about 150 kcal. Although energy provided from the hospital diet in both groups was similar, hospital meal wastage in the TMD group was higher than in the regular diet group. Conclusion : The older adult inpatients on TMD may have a nutritional status worse than those consuming a regular diet. Hospital diets need to be improved in texture and quality. J. Med. Invest. 69 : 230-236, August, 2022.